As a rural ER doctor, I feel guilty cutting back my hours. But it’s the only way for me to keep working

This First Person article is written by Dr. Sarah Giles, who works in Kenora, Ont. For more information about CBC’s First Person stories, please see the FAQ.
I’m a rural emergency room doctor — and I feel the need to publicly apologize. 
I’m sorry that many of you are often not receiving the health care you need, in the right place or at the right time. And I’m sorry that many of you don’t have a primary care provider, that wait times are so long and that I sometimes see you in the hallway where you have little privacy. While this happening in our rural hospital in Kenora, Ont., I’ve seen similar experiences reflected in emergency rooms across the country.
So, I need you to believe me when I say that my colleagues and I cannot fix these problems ourselves. In fact, trying to fix the problem has pushed some of us to the point of leaving the profession — and the effort to look after ourselves may worsen services.
I no longer work as many ER shifts as I did in the past; I may never get back to that number. These days, I rarely eat or pee during my shift, which lasts, on average, 10 hours. I stay overtime for every single shift. 
The ER is full of people who continuously — and genuinely — need us to go the extra mile: people are sicker and their illnesses more complex than ever. I often have difficulty getting the OK to move critically ill patients from our small hospital to larger ones in Thunder Bay, Ont., or Winnipeg, due to staffing and bed shortages there, too. I can find myself begging — literally begging — for what patients need. 
And I often fail. 
In 2023, I made the ER schedule and naively put myself down for every long weekend between Easter and Thanksgiving. It was part of a team effort to keep the doors open that summer, but I finished burnt-out and angry. 
I learned that patients and their families often don’t know that doctors are working themselves into the ground; they just expect the ER to be open. That’s a reasonable expectation, but for me it comes with a high personal cost.
Burnout meant I dreaded going to work. I started to anticipate the feeling of impending doom that began days ahead of each shift. 
In a bid to lessen my anxiety, I started arriving at work earlier and staying later. But my job left me feeling impotent; I felt like a failure when I couldn’t get my patients the help that they needed, regularly watching patients with broken hips wait days to get flown out for surgery.
I frequently found myself completely overwhelmed and reduced to tears. Consumed by the problems at work, I had trouble sleeping. In the past, I’d always been able to out-work problems in my life, but longer hours just made the problem worse.
Last October, I called my department head and said I needed to drastically reduce my shifts or I was going to end up quitting.
As a former humanitarian doctor in conflict zones, I have seen what happens when people don’t have access to health care, and I was beyond stressed when I imagined being at home resting while a neighbour, a friend or any person died. 
But I could not continue with the status quo. 
When I took on fewer shifts, I felt as though I was letting everyone down. But the ER didn’t close, and I realized I could finally breathe again. In asking for help, I put on my proverbial oxygen mask first and started taking care of myself.
The decrease in my hospital hours gave me time to recover emotionally and physically between shifts. I forced myself to consciously develop new hobbies, such as playing the piano and meditating, that were not related to work and made me feel happier.
These days, there are weekly emails from my hospital asking local doctors to pick up extra ER shifts. I know the hospital administration understands that these local doctors, all of whom are rural generalists who work in other parts of the community and hospital, have also given as much as possible and our reserves are dry.
Many of us have learned through burnout, illness and relationship breakdowns that working more doesn’t translate into the stabilization of ER services — it may lead to more doctors leaving their rural communities. But I’ve been told the hospital is asked by the ministry to show it has exhausted every possibility before closing down the hospital. So the emails continue. 
I have learned that the best way I can help with the staffing crisis is to keep myself healthy, work my designated shifts and occasionally pick up a vacant shift. I have become resigned to the fact that, in all likelihood, our ER — like so many others — will start to have periods of closure in the near future. With only 11 local doctors currently working in our ER, down from 22 we had four years ago, no one person is going to fix the problem.
That’s why I’m asking for both forgiveness and understanding from the public. 
But what I really need to ask for are changes that move the stress of keeping rural services open off of the people working in hospitals and back onto the politicians and civil servants responsible for the health-care system.
I am sorry that the health-care system is unable to meet all of your needs. I have tried to fix the problem and failed. I can, however, reassure you that, though I may be working fewer hours, I am much more likely to stay in this community, working in the ER, for the long term. 
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